EANM FDG PET/CT accreditation program
Arturo Chiti, Ronald Boellaard, Sabine Ettinger, Andrea Bauer,
Sigrid Stroobants, Klaus Tatsch, Wim Oyen, Patrick Bourguet
3rd International Workshop on Interim PET in Lymphoma
Menton , September 26-27th, 2011
The EANM guideline for FDG PET and PET/CT
provides recommendations for:
• Minimizing physiological or biological effects by patient preparation guidelines
• Procedures to ensure accurate FDG administration
• Matching of PET study statistics (‘image quality’) by prescribing FDG dosage as
function of patient weight, type of scanner, acquisition mode and scan duration
• Matching of image resolution by specifying image reconstruction settings and
providing activity concentration recovery coefficients specifications
• Standardization of data analysis by prescribing region of interest strategies and
SUV measures
• Multi-center QC/QA procedures for PET and PET/CT scanners
Why do we need a guideline for quantitative FDG PET/CT ?
0 1 2 3
Hospital
4.00000
8.00000
12.00000
16.00000
SU
V 5
1-61
min
nor
mal
ised
to
wei
ght
scan
1
�
Recent (2009) observation on site differences in SUV
-Site 1 & 2 closely followed NL standardized protocol
-Site 3 did not – almost a factor of 2 lower SUV on average
Outcome of quantitative FDG-PET studies using standardized
uptake values depend on many biological and technical factors
*Example of one of the many small factors: effects of different number of OSEM iterations, on SUV
SUVmax = 4.0 5.9 6.4 8.6
SUV 50%= 3.0 4.1 4.6 5.9
Impact of blood glucose level
Glu 200 mg% Glu 79 mg%Karoline Spaepen-Sigrid Stroobants
Department of Nuclear Medicine
University Hospital Gasthuisberg
Leuven, Belgium
Factors affecting SUVbiological factors – uptake period
Lowe VJ et al. Optimum scanning protocol for FDG-PET evaluation of pulmonary malignancy. J Nucl Med. 1995, image taken from Shankar et al. JNM 2006
Scanner validation programs
• Usually performed as part of imaging site accreditation to
check (minimal) PET/CT system performance
• Accreditation organisations have different scanner
validation procedures
• There is not a unique phantom adopted by all groups
Need for harmonisation of resolution-dependent quantitation, rather than minimal performance standards
0 1 2 3
Hospital
4.00000
8.00000
12.00000
16.00000
SU
V 5
1-6
1 m
in n
orm
alis
ed t
o w
eight
sca
n 1
�
Types of standards / recommendations
• Minimal performance standards:
– “Focus” on accuracy
– Lower threshold
• Harmonising performance standards
– “Focus” on reducing inter-institute, -scanner, -patient variability –’precision’
– Lower and upper limits
Multi-center QC and calibration
• Daily QC conform standard procedure of system /
manufacturer
• Calibration QC using (cylindrical) phantom (15-30 cm
diameter)
• “Adjusted” NEMA NU 2-2001 Image Quality
procedure/measurement to measure recovery coefficients
as function of sphere size (= ‘effective image resolution’)
• CT-QC cf recommendations of ESR/national law
• Misc. QC (e.g. for scales, alignment etc)
Absolute activity concentration recoveries –
NEMA NU 2 2001 IQ Phantom
Activity concentration recovery
0.000
0.200
0.400
0.600
0.800
1.000
0.1 1 10 100
avg0.00
0.25
0.50
0.75
1.00
0 2 4 6 8 10 12
Sphere volume (ml)
Rec
ove
ry c
oef
ficie
nt
w/o with standardisation
Right figure: Average (+/- 1 SD) activity concentration recovery coefficients as function of sphere size observed with image quality quality control measurements at 8 different scanners
Based on the QC experiments as described in the EANM guideline
published in EJNMMI 2010
Manuals, SOPs, online questionnaire completed in August 2010
Training of EARL coordinator (S. Ettinger) September 2010
Pilot program (in collaboration with EORTC) began in October 2010
with 11 sites (12 PET/CT systems)
European accreditation program
EARL, EANM, EORTC
Standardised software tools for analysis and interpretation of
QC experiments were developed:
European accreditation program
EARL - EANM, EORTC
Calibration QC:
- Automatic VOI placement
- Verification of calibration
- Verification of inter-&intra-plane uniformity
IQ QC
- Recovery coefficients (volume & act.conc.)
- Cold spot recovery using central insert (scatter)
- Verification of calibration using back ground VOI
Now: next phase of program is ongoing
Accreditation within
trial EORTC_22071-24071: basic calibration
• 11 sites (12 PET/CT systems)
• 2 sites needed re-calibration and/or adjustment of reconstruction settings
PET calibration results - EORTC Trial 22071-24071
0.8
0.9
1
1.1
1.2
1 2 3 4 5 6 7 8 9 10 11 12
Site/scanner
SU
V in
cyl
ind
er (
sho
uld
be
1.0)
Q4 2010
Q1 2011
Accreditation: in progress
• In July 2011: 7 sites joined
• In October 2011: 12 sites are joining
• In January 2012: 7 sites / 9 scanners are joining
• Q1 2012: 37 sites with 40 scanners expected
• Program is now open for all interested sites
– Yearly certification with quarterly QC reports
FDG PET and PET/CT: EANM Procedure Guidelines for
Tumour PET Imaging Version 2.0
Mutual recognition of different accreditation programs
Standardization of response criteria
Standardization of reporting
EANM: next steps
Top Related